Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index

Claudia Costa, Paula Santana, Sani Dimitroulopoulou, Bo Burstrom, Carme Borrell, Jürgen Schweikart, Dagmar Dzurova, Nicolás Zangarini, Klea Katsouyanni, Patrick Deboseree, Ângela Freitas, Christina Mitsakou, Evangelia Samoli, Sotiris Vardoulakis, Marc Marí Dell’Olmo, Mercè Gotsens, Michala Lustigova, Diana Corman and Giuseppe Costa
Additional contact information
Claudia Costa: Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal
Paula Santana: Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal
Sani Dimitroulopoulou: Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK
Bo Burstrom: Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, 171 77 Stockholm, Sweden
Carme Borrell: Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
Jürgen Schweikart: Department of Civil Engineering and Geoinformation, Beuth University of Applied Sciences Berlin, 13437 Berlin, Germany
Dagmar Dzurova: Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic
Nicolás Zangarini: Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
Klea Katsouyanni: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
Patrick Deboseree: Interface Demography, University of Brussels, 1050 Brussels, Belgium
Ângela Freitas: Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal
Christina Mitsakou: Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK
Evangelia Samoli: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
Sotiris Vardoulakis: Institute of Occupational Medicine, Edinburgh EH14 4AP, UK
Marc Marí Dell’Olmo: Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
Mercè Gotsens: Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
Michala Lustigova: Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic
Diana Corman: The National Board of Health and Welfare, 106 30 Stockholm, Sweden
Giuseppe Costa: Medical School of the University of Turin, University of Turin, 10124 Turin, Italy

IJERPH, 2019, vol. 16, issue 5, 1-17

Abstract: The different geographical contexts seen in European metropolitan areas are reflected in the uneven distribution of health risk factors for the population. Accumulating evidence on multiple health determinants point to the importance of individual, social, economic, physical and built environment features, which can be shaped by the local authorities. The complexity of measuring health, which at the same time underscores the level of intra-urban inequalities, calls for integrated and multidimensional approaches. The aim of this study is to analyse inequalities in health determinants and health outcomes across and within nine metropolitan areas: Athens, Barcelona, Berlin-Brandenburg, Brussels, Lisbon, London, Prague, Stockholm and Turin. We use the EURO-HEALTHY Population Health Index (PHI), a tool that measures health in two components: Health Determinants and Health Outcomes. The application of this tool revealed important inequalities between metropolitan areas: Better scores were found in Northern cities when compared with their Southern and Eastern counterparts in both components. The analysis of geographical patterns within metropolitan areas showed that there are intra-urban inequalities, and, in most cities, they appear to form spatial clusters. Identifying which urban areas are measurably worse off, in either Health Determinants or Health Outcomes, or both, provides a basis for redirecting local action and for ongoing comparisons with other metropolitan areas.

Keywords: Population Health Index; Europe; metropolitan areas; health determinants; health outcomes; municipalities (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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